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General NPI Number Information
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NPI Number | 1740329093
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Entity Type | Organization
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Legal Business Name | BARRY E. BOOTH, D.D.S., M.S.
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12635 W 143RD ST
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City | HOMER GLEN
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State | IL
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Zip | 60491-8381
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Country | US
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Telephone | 708-301-0005
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Fax | 708-301-0063
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Provider Business Mailing Address
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Address Line | 12635 W 143RD ST
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City | HOMER GLEN
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State | IL
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Zip | 60491-8381
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Country | US
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Telephone | 708-301-0005
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Fax | 708-301-0063
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY E. BOOTH
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Credential | D.D.S., M.S.
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Telephone | 708-301-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | IL
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